By Roy Hezron
The Teachers Service Commission (TSC) has maintained that Minet Kenya will continue to provide medical cover for teachers adding that only the National Assembly can object the decision.
The Commission’s Director of Legal, Labour and Industrial Relations Cavin Anyuor has however noted that the new contract has exponentially improved the benefits teachers are entitled to and urged teachers and union leaders to assist the commission to hold the service provider to account.
While addressing the 24th Kenya Union of Post Primary Education Teachers (KUPPET) Annual Delegates Conference (ADC) on December 10, 2022 in Murang’a County, Anyuor stated that in the new contract; the lowest Job Group, B5 which was initially entitled to an in-patient cover of Ksh 750,000 has now been adjusted to Ksh 1 million.
He added that the highest job group, D5 which was initially entitled to an in-patient cover of Ksh 2 Million will now receive Ksh 3 million in the current contract.
Anyuor also revealed that in the new contract, they have created a governance structure [which was not there before]; which has a Contract Implementation Committee, with members of teachers’ unions up to the county level; and further has 370 mission, government and private hospitals.
He further revealed that the issues of pre-authorization, few contracted medical service providers, and the 7-day rule have been scrapped off in the new contract.
According to Minet the reason for pre-authorisation was to verify validity of the services requested, benefit adequacy and proposed costs in order to safeguard members’ benefits and ensure scheme sustainability.
Under pre-authorisations, the service provider normally initiates an online request for approval of a certain service.
These services include; inpatient services (medical and surgical) and day cases which include Colonoscopy, some excision and biopsy cases, chemotherapy and radiotherapy, post kidney treatment among others; maternity services, dental, and optical.
On the 7-day Rule the service provider was required to provide quality services to all the teachers without warranting a return to hospital for primary healthcare unless for a different diagnosis or a complication.
According to Minet, if a member was to return to hospital within 7 days for the same condition, the agreement was that the member should be attended to and the visit should not be charged to the members account nor asked to pay out of pocket.
